A Responsible Vote on Question 3: Medical Marijuana Will be A Major Mess.

It seems to me that the debate over the legalization of medical marijuana (question 3 on tomorrows’ ballot) can be broken down pretty simply.  Individuals who want to smoke marijuana are for it and those that don’t are against it.  While personal preferences are a part of life, when it comes to good medicine and sensible health policy it is important to consider things on a broader level.   When we examine the science and the implications there can be no doubt: We should not legalize medical marijuana. 

 Putting medical decision making into the hands of the general public is dangerous practice.   Science and not the whims of people should govern health policy and medicine.  I am not neccesarily opposed to medical marijuana, just this particular question.  As  a physician if science could convince me that medical marijuana (a) had clear medical benefits that outweighed harms (b) improved people’s overall functioning and productivity for specific well defined medical problems with known mechanisms of disease and, most importantly of all (c) would not lead to gross abuse of the distribution system and become a vehicle for contributing to individuals substance abuse than I would be for this bill.  The facts are that the medical science is not there to support this bill and none of that above mentioned criteria exists.  This way this question is written is dangerous. We don't know if it would make people worse or better and until we do we should avoid using it as medicine. 

I have no personal vendetta against people who want to smoke marijuana recreationally.  As a physician I think substance abuse of any kind is bad for the soul and I empathize with people who suffer from addictions that alter brain chemistry of any kind be it alcohol, drugs, tobacco, prescription drugs or food.   Marijuana is no different.  

As I see it the problem with medical marijuana use is three fold.  First and foremost the health effects of marijuana are unknown.  There are some concerning signs but nobody really knows what repeated marijuana use does to brains, lungs, and reproductive systems of human beings over the long haul. Many studies have shown adverse effects on these organ systems and others in animals and humans but more science needs to be done.  Dose for dose, marijuana has much more tar and carcinogens than tobacco does but people tend to use less marijuana than tobacco.  How does this effect the development of disease?  No one knows.

There are hundreds of chemicals in a marijuana plant and I would bet that some of these have some beneficial physiologic effects.  I am in favor of researching these chemicals, harvesting their benefits in a safe and controlled way and making medicines from them (after all how could they be worse than many treatments we currently use, especially opiates??????).  But many of the hundreds of poorly studied chemicals in marijuana are harmful as well.  At the present time based on the scarcely available science to me it seems that smoking marijuana to get a small physiologic or symptomatic benefit in light of these potential harms is similar to eating a McDonald’s cheeseburger to getting the health benefits from the lettuce and tomatoes.  

The second problem (and the major problem for me) is that the medical system has proven that it is woefully incapable of responsibly managing the dispersal of potentially addictive substances.  Based on the available medical evidence physicians should rarely if ever be writing for medicines like Ativan, Percocet, Dilaudid or Ambien.  These medicines have very narrow therapeutic windows and are dangerous, addictive and not beneficial in the long term.  Yet doctors continue to irresponsibly dispense them every day in mass.    The opiate epidemic alone is evidence enough that physicians struggle to dispense potentially dangerous substances judiciously.  Forget addictive substances: physicians can’t even get antibiotic prescriptions right!

If Medical marijuana passes be ready for rampant abuse of the system.  If this question was written to give marijuana to people with terminal diseases and prognosis of less than 6 months to live than I also probably would be for it, but thats not what will happen.  Medical Marijuana will end up being given mostly to people with chronic diseases.  An entire legion of people with nebulous and poorly defined medical conditions like fibromyalgia, bipolar disease, ADHD, chronic pain, depression, cyclic vomiting syndrome and many, many more “photo shop” diseases will be waiting in line for medical marijuana because sufferers have co-morbid substance abuse problems and want to get stoned.  Some will convince well meaning but poorly informed physicians they have one of these poorly defined conditions and get prescriptions. And irresponsible or weak minded doctors who don’t care that much about patients  will simply oblige them.   People with certain chronic diseases will even be allowed to grow pot in their back yards.
  
A third problem pertains to the larger social implication of marijuana use.    Consider the example of tobacco.  Tobacco use was widespread for hundreds of years before we discovered not only the adverse personal health consequences but also the larger social cost.  If we legalize marijuana we will normalize it.     When we normalize it much like tobacco we will then see the individual and social unintended consequences of a substance with hundreds of chemicals of unknown physiologic effect. 

I took an oath to do no harm and I take that serious. To me that means that everything I do for a patient should come only after rigorously controlled studies of the harms and the benefits of a medicine are conducted under scientific conditions.  Clearly no such process has happened for marijuana.

The fact is that there is scarce medical evidence showing any long term clinical efficacy of medical marijuana to improve outcomes, enhance quality of life or improve functioning for distinct medical problems.  We can’t say for sure these individuals will be better off 5, 10 or 20 years down the road if we give them marijuana because we don’t know.  Many people like getting stoned, but dealing drugs is not good medicine.  And just like the millions of opiate addicts medicine has created, guess who will be paying to support these people, their addiction and their basic needs?   Our already strained system that we all contribute too.  

I think the current system works fine.  Marijuana is illegal but no one I know who smokes marijuana seems to have a hard time getting it or gets in much trouble for it.  It remains somewhat on the fringe of society and people can smoke it recreationally as they wish with relative ease.  If it's not broke don't fix it.

Opiates, which admittedly are more addictive than marijuana, have become a scourge on our civilization propagated by modern medicine.  Legalizing medical marijuana will result in manifold abuse of the system and create a similar mess.  It will ultimately serve to further worsen our ever burgeoning problem with addiction.  It will be proven to be a clinically ineffective treatment that may have some palliative effect at the expense of worsening substance abuse problems and hindering functioning and productivity in our most physically and psychologically vulnerable populations.  It will lead to health consequences.  

In closing I offer a hypothetical question:  If a drug company came out with a drug that had hundreds of chemicals in it (at least 400 at last count) with unknown short or long term physiologic effects, had not been studied in any clinical trails or under any real scientific conditions, had in some studies been linked to cancer but in other studies not been, could offer little information on the benefits or harms, was known to be physically and psychologically addictive and might offer some short term slight palliative effects at the expense of making users less productive and functional would any voter in their right mind vote yes on a question asking doctors to use it medically?  This is exactly the question we are faced with tomorrow.    
I get that some people like to smoke marijuana recreationally and I don’t judge them for it, but a responsible vote is a No vote on Question 3.